The benefits of aspirin therapy

Low-dose daily aspirin therapy has proved beneficial to older people with a high risk of heart attack or stroke.

Dr. Evan Lipkis, a physician based in Glenview, checks the pulse of a patient.courtesy of Steve Lasker Photography

By Evan Lipkis, MDSpecial To The Daily Herald

Aspirin is a common, over-the-counter remedy and yet, how much do you really know about this often used drug?

What is aspirin?

Aspirin was discovered in the United States in 1850 and is derived from the bark of willow trees. Long known as the "Wonder Drug," aspirin is inexpensive and readily available at retail stores and pharmacies everywhere.

Carter Black, a registered pharmacist and consultant with Keefer's Pharmacy in Mount Prospect and Petranek's Pharmacy in Libertyville, says that generic aspirin is as efficient as more costly brand name aspirin.

Patients should be careful about the interaction of aspirin and prescription drugs.

Black advises patients to maintain a list of their medications and to always bring the list to their pharmacist when purchasing prescriptions.

According to Black, "It is imperative for the pharmacist to double-check the patient's medications to be certain there are no dangerous interactions with aspirin."

Can aspirin reduce heart attacks, strokes?

The simple answer is yes. Aspirin will greatly help a middle-aged male smoker who has high blood pressure, diabetes and high cholesterol versus the same man who has no cardiac risk factors whatsoever.

In general, low-dose aspirin is recommended for men age 45 to 79 and women age 55 to 79. These are the ages where the risk of bleeding is usually offset by aspirin's cardiovascular benefits.

Interestingly, the benefits are different for men and women. For men, the benefit is to prevent a heart attack. For women, the benefit is to prevent a stroke.

The more risk factors, the greater the benefit. Unfortunately, many people who could benefit from aspirin therapy don't bother to take it.

A study conducted in 2007 that was published in the Journal of General Internal Medicine concluded that 14 percent of men and 20 percent of women who were ideal candidates for daily aspirin therapy were not taking it, potentially resulting in thousands of premature deaths every year.

The physicians website, Uptodate.com, estimates that 5,000 to 10,000 additional lives might be saved every year if all the patients who were hospitalized for heart attacks undertook aspirin therapy. The research results appear very promising.

Aspirin is not without the potential for side effects. Even a baby aspirin can cause silent ulcers and gastrointestinal bleeding. Very rarely, hemorrhagic strokes resulting from bleeding in the brain could occur.

Allergic reactions, upset stomach, heartburn, and ringing in the ears are possible side effects. Increasing age and previous intestinal bleeding are risk factors for having bleeding from aspirin.

Proton pump inhibitors such as omeprazole or Prilosec can reduce the chances of such bleeding by over 90 percent.

Rarely, regular use of aspirin is associated with a small but statistically significant increase in the risk for neovascular age-related macular degeneration (AMD). This is the leading cause of blindness in the USA.

For people considering aspirin therapy, it is important to weigh the benefits against the risks. In most cases, the higher your cardiovascular risk, the better to begin aspirin therapy. As always, consult with your doctor.

What are the risk factors?

Recent studies indicate that a daily aspirin regimen lowers the risk of heart attack or stroke for people who smoke, are overweight, don't exercise, have high blood pressure, high cholesterol, diabetes or a family history of cardiovascular disease.

The American College of Cardiology and the American Heart Association advise men and women to consider a daily aspirin regimen if they are age 50 or older and their 10-year risk of stroke or heart attack is higher than 10 percent.

However, some cardiologists believe such people should not take daily aspirin unless their 10-year risk is above 20 percent.

Can aspirin prevent cancer?

Many studies show that when aspirin is taken daily, mortality decreases for many solid tumors such as breast, colon and prostate.

Melanomas may be reduced in postmenopausal, Caucasian women.

This drug can also reduce the spread or metastasis of cancer.

Aspirin can cause intestinal and intracranial bleeds so these risks need to be discussed with your physician before beginning a daily aspirin regimen.

Does aspirin have any other benefits?

After having a blood clot, a daily aspirin can reduce future blood clots by 30 percent. Blood clots contribute to one out of every five deaths.

Aspirin helps with arthritis complaints and reduces the rates of heart attacks. Other anti-inflammatories increase the incidence of heart attacks. Depression is likely an inflammatory condition of the brain. Aspirin may help to reduce this ailment in older men with elevated homocysteine levels.

Homocysteine is a risk factor for heart disease and can be easily measured by a routine blood test.

It may also reduce cardiovascular mortality in patients with heart failure. After a careful review of 23 individual studies, the government-backed U.S. Preventive Services Task Force now recommends pregnant women begin low dose aspirin therapy after their first trimester. The low dose aspirin therapy reduces the chances of developing pre-eclampsia, a potentially fatal complication, by 24 percent.

What is the right dose to take?

In almost all circumstances, low dose aspirin (81mg) is preferred.

Lower doses reduce intestinal bleeds by 50 percent. During a heart attack, a full aspirin (325 mg) is recommended and can be swallowed or chewed.

The American College of Cardiology and the American Heart Association recommend a daily 81-milligram aspirin tablet for people who have survived a heart attack or experienced a stroke or near-stroke (TIA) as long as the patient can safely tolerate it.

Take aspirin with food and with a full glass of water. Enteric-coated tablets are more costly and are not any safer than a standard aspirin tablet.

In fact, coated or buffered aspirin pills are advertised as being gentler on the stomach. But, recent studies suggest coated or buffered aspirin pills may not be effective at preventing clots. It would be best to choose uncoated aspirin tablets. Finally, taking an aspirin at night does not help reduce heart disease any better than a morning dose.

Is aspirin dangerous?

If you are on a daily aspirin regimen, never mix it with pain relievers such as naproxen (Aleve and generic) and ibuprofen (Advil and generic) because the risk of bleeding will increase significantly.

Instead, consider acetaminophen (Tylenol and generic) for pain relief. However, if you are taking acetaminophen for pain and frequently consume three or more alcoholic beverages per day, you will greatly increase your risk of liver damage.

After you have begun daily aspirin therapy, don't suddenly stop.

Evidence indicates that your risk of heart attack or stroke will significantly increase.

If you are scheduled for a surgery, check with your doctor in advance to determine if you should continue aspirin therapy or not.

Always read the label carefully before taking any medications.

• Evan Lipkis, M.D. is a physician, author and lecturer based in Glenview. The advice contained in this article is for informational purposes only. Readers should consult with a physician to evaluate any illness or medical condition. For inquiries about this article or to receive a free Lifesavers newsletter, contact Dr. Lipkis at: www.drlipkis.com.

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